Year 2016 Vol. 24 No 2

GENERAL & SPECIAL SURGERY

K.M. KURBONOV1, F.I. MAKHMADOV 1, N.A. RASULOV 2, K.R. NAZIRBOEV 1, U.U. MANSUROV 1

CAUSES AND TREATMENT TACTICS OF "FRESH" INJURIES OF THE BILE DUCTS

Avicenna Tajik State Medical University1,
SEE "Institute of Post-graduate Education in the field of Public Health of the Republic of Tajikistan"2, Dushanbe,
The Republic of Tajikistan

Objectives. Improvement of treatment results of bile duct injuries.
Methods. The study is based on the analysis of the clinical examination results of patients (n=74) with injuries of bile ducts (IBD). Presence of IBD during surgery was detected in 18 (24,3%) patients, in 56 (75,7%) patients bile duct injuries were revealed in different terms after surgery. The various clinical-laboratory and instrumental methods used for the diagnosis of IBD.
Results. In the majority of cases (41; 55,4%), according to the classification of H. Bismuth and E.I. Galperin the high bile duct injury was observed. A common manifestation of "fresh" injuries was bile expiration along the control drainage, which was noted in 39 (52,7%) cases out of 74 observations of IBD patients. To detect IBD complete ultrasonography was performed in 61 (82,4%) patients, accumulation of bile within the free peritoneal cavity was established in 46 (62%) cases, and the expansion of the intrahepatic bile ducts in 12 cases. To identify the source and causes of postoperative intraperitoneal bile leakage MR pancreatocholangiography was performed in 14 cases.
The patients (n=21) with IBD underwent to various variants of restorative interventions, including endoscopic stents (n=2). In different incisional periods in 14 (19%) cases the disease was complicated by scar strictures of the bile ducts with cholangitis (n=8), requiring repeated reconstructive operations. In the early postoperative period 8 complications mainly observed after applying interchangeable transhepatic drainages in reconstruction operations: hematobilia (n=3), obstructive abscess (n=3), the migration of drainage from the anastomosis zone (n=2). Lethal outcome occurred in 3 cases.
Conclusion. The bile ducts injuries develop due to the "predisposing" and "contributing" factors. For small injuries it is advisable to use endoscopic stenting, and at high and extended injuries Roux reconstruction seems to be the method of choice.

Keywords: cholecystectomy, complications, iatrogenic trauma, injuries of the bile ducts, biliodigestive anastomoses, drainage, lethal outcome
p. 120-124 of the original issue
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Address for correspondence:
734003, Republic of Tadzhikistan,
Dushanbe, pr-t. Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy meditsinskiy universitet imeni Abuali ibni Sino, kafedra khirurgicheskih bolezney 1,
tel.: 992 93 405-44-04,
e-mail: dr.hero85@mail.ru,
Nazirboev Kahramon Ruziboevich
Information about the authors:
Kurbonov K.M. MD, professor, an Academician of the Academy of Medical Sciences, an Honored worker of Science and Technology of the Republic of Tajikistan, a head of the chair of surgical diseases 1 of Avicenna Tajik State Medical University.
Makhmadov F.I. MD, an associate professor of the chair of surgical diseases 1 of Avicenna Tajik State Medical University.
Rasulov N.A. PhD, an associate professor, a head of the surgery chair of SEE "Institute of Post-graduate education in the field of Public Health of the Republic of Tajikistan".
Nazirboev K.R. PhD, an assistant of the chair of surgical diseases 1 of Avicenna Tajik State Medical University.
Mansurov U.U. A post-graduate student of the chair of surgical diseases 1 of Avicenna Tajik State Medical University.
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